Washington L&I Selects Fair Isaac Program for Workers’ Comp Claims

Fair Isaac Corporation, a provider of analytics and decision technology, announced that the Washington State Department of Labor and Industries (L&I) has licensed VeriComp Fraud Manager to enhance its workers’ compensation fraud and abuse detection capabilities. VeriComp Fraud Manager will reportedly enable L&I to detect fraud and abuse much earlier and more accurately, while also identifying claims in need of additional case management.

VeriComp Fraud Manager scores claims on the likelihood of fraud and abuse. The software helps organizations fast-track normal claims while identifying claims that are out of profile compared to their peers. This rank-ordering helps adjusters focus their attention on suspicious claims with minimum effort, lowering costs and enhancing efficiency.

As one of the nation’s 10 largest workers’ comp insurers, the Department of Labor and Industries provides workers’ comp insurance coverage to about 70 percent of Washington’s workers.

In addition to rapidly identifying fraudulent and abusive claims, VeriComp Fraud Manager can discover cases with high cost or long duration potential, enabling adjusters to apply more aggressive case management and medical intervention earlier in the life of the claim. Using Fair Isaac’s advanced predictive analytics, VeriComp Fraud Manager can recognize subtle patterns of abuse that even the most experienced adjuster might miss.

Nationally, it is estimated that fraud and abuse account for at least 10 percent of the cost of workers’ comp premiums. The vast majority of workers’ comp fraud reportedly goes undetected, and if fraud is caught at all, it is usually late in the life of the claim.

According to the National Insurance Crime Bureau (NICB), workers’ comp fraud costs Americans more than $5 billion nationally.